CASE PRESENTATION

Roll No. 100-108

Special Thanks
Dr. Pooja Kukreja
 CASE
A Proud smoker of cigarettes
for last 15 years @ 20 cigarettes a
day is having cough for
45 days.
 KEY FINDINGS

Chronic smoker (15 years).

Smoking 20 cigarettes / day

Cough since 45 days

PATHOLOGIES MANIFESTING
COUGH
Respiratory System
Cardiovascular system
Mediastinal disease
Psychogenic
Reflex
ACE inhibitors therapy
RESPIRATORY PATHOLOGIES WITH COUGH
S. No. Origin Common causes Characteristics

1. Larynx Laryngitis and tumor Harsh and painful cough

2. Trachea Tracheitis Pain with coughing

3. Bronchi COPD Dry, Morning
Asthma Dry, Night
Bronchial carcinoma With haemoptysis
4. Lung Parenchyma TB Productive with haemoptysis
Pneumonia Dry, Productive
Brochiectasis Mucopurulent with
Pulmonary Oedema haemoptysis
Fibrosis Cough with pink frothy
sputum
Dry irritant distressing cough
 SMOKING

Obstructive Restrictive Carcinoma

Diseases Diseases

COPD Asthma

DIP RB-ILD
 COPD
Bronchial & Brochiolar Injury Destruction of alveolar wall

Bronchospasm Infection Respiratory

Infection

Reversible obstruction Emphysema

in bronchioles & small
bronchi

Persistent Infection Persistent Infection

Injury Injury

Chronic bronchitis

COPD
 ASTHMA
Allergens

Cell activation

Release of mediators

Effects

Bronchospasm Mucus Structural

hypersecretion changes
RESTRICTIVE DISEASE
Persistent inflammation
and injury

Fibrosis
 CARCINOMA
Smoking

Initiators & Promoters

Oncogenes activation
(C-MYC, K-RAS, EGFR etc.)

Suppression of tumor suppressor genes

(p53, RB, p16 etc.)

Neoplasm

Squamous cell Adeno Small cell Large cell

carcinoma carcinoma carcinoma carcinoma
 APPROACH TO PATIENT
(INVESTIGATIONS)
History

Physical examination

Routine investigations (CBP / ESR /

Peripheral smear]
OXIMETERY.

SERUM ALPHA1 ANTITRYPSIN LEVELS.

 RADIOLOGY

X-ray

CT Scan & HRCT Scan

MRI
PULMONARY FUNCTION TESTS

Tests Obstructive Restrictive

diseases diseases

TLC N,  

RV  , , N

VC  

FEV1 / FEC  N, 
 BRONCHOSCOPY
VISUALIZATION

SAMPLE
COLLECTION
 CYTOLOGY
Sample Collections

Staining or culture

Neoplastic cells Microorganism

Carcinoma Infection
 Squamous Cell Carcinoma :
Keratinised, prominent
perinuclear halo,
hyperchromatic nuclei.

Small Cell Carcinoma :

Loose cluster,
Pleomorphic,
inconspicuous nucleoli
 Large Cell Carcinoma :
Necrosis,
undifferentiated, nuclear
pyknosis

Adenocarcinoma :
Rounded nuclei,
prominent nucleoli.
 BIOPSY
Sample collection & staining

Types of bronchogenic carcinoma :-

 Squamous cell carcinoma
 Small cell Carcinoma

Adeno Carcinoma

Large cell carcinoma
SMALL CELL CARCINOMA
Small cells
Scant cytoplasm
Ill defined cell borders
Fine granular nuclear
chromatin
Absent nucleoli
High mitotic count
Extensive necrosis
Island appearance
 ADENOCARCINOMA

Glandular appearance

Well differentiated
 LARGE CELL CARCINOMA

Highly undifferentiable

Large nuclei

Prominent nucleoli

Moderate amount of
cytoplasm
SQUAMOUS CELL CARCINOMA
Keratinisation

Pearly appearance

Eosinophilic cytoplasm
 TUMOUR METASTASIS

Brain Scan

Bone Scan

Liver Scan
PARANEOPLASTIC SYNDROMES

Measurement of :


Hormonal level


Electrolytes

 Liver function tests etc.

 MESSAGE

SMOKING IS
INJURIOUS TO
HEALTH